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Thursday, 17 November 1983
Page: 2939

Question No. 596

Dr Everingham asked the Minister for Health, upon notice, on 11 October 1983:

(1) Has his attention been drawn to plans of the United Kingdom organisation, Action for Research into Multiple Sclerosis (ARMS), to establish 40 treatment centres to contain a 3.72 tonne 3 metre diameter pressure chamber designed by Kelistone Marine Ltd of Suffolk and which is able to accommodate 6 handicapped persons at a time who can be observed through a window.

(2) Is he able to say whether ARMS believes their proposed hyperbaric treatment will delay, possibly arrest and at times relieve multiple sclerosis following observations over 3 years in the United Kingdom and the United States of America .

(3) Will he investigate current assessments of this type of treatment with a view to possible public support of one or more pilot treatment centres in Australia and the South Pacific.

Dr Blewett —The answer to the honourable member's question is as follows:

(1) Yes.

(2) ARMS-Action for Research in Multiple Sclerosis is a voluntry self-help charity managed by a committee of people with multiple sclerosis (MS) to raise money and conduct research into this disease.

The organisation is generally sponsoring, supporting and managing those avenues of research which its management committee feels have been less than adequatley funded and supported from traditional sources.

One of the stated aims of ARMS is to enable the maximun number of multiple sclerosis people to benefit from the use of the hyperbaric oxygen chamber in the search of better disease management techinques.

The Organisation's assessment of the situation is that in view of the evidence it is correct to make this treatment available to as many chronic sufferers as possible. The ARMS contends that whilst hyperbaric oxygen may be unable to prevent progression in some cases and that it is not a cure, it can offer improvement of a significant nature to between one third and one half of sufferers and that repeated treatment is required to maintain improvement.

(3) Although there have been many reports over 30 years of beneficial effect on the progress of multiple sclerosis of hyperbaric oxygen, all the reports have been of studies performed without controls and not using an established disability to scale to measure to effects. All the studies did indicate a positive effect from the treatment.

One only randomized, double-blind, placebo-controlled trial has been reported in the medical literature: that of Fischer et al, published in the New England Journal of Medicine, Vol. 308, No. 4, on 27 January 1983. This study involved 40 people divided into 2 groups-one group received placebo treatment. The participants were followed up for one year. This study supported results of previous uncontrolled studies and demonstrated a mild and transient improvement in most patients. It showed that those with milder disease of short duration derived a more pronounced and longer lasting benefit.

In concluding his report Fischer emphasised that the results should be received with caution and regarded as preliminary. They require confimation by other independent research centres. The author stated that the results indicated that furter consideration should be given to hyperbaric oxygen as a treatment for multiple sclerosis but that it could not yet be generally recommended for these patients.

In the UK an uncontrolled study was carried out by Dr Phillip James, Senior Lecturer in Occupational Medicine, University of Dundee, on behalf of ARMS. A report of this study by Dr Duncan Davidson, who is the Consultant Neurologist to the Tayside Health Board and Hon Senior Lecturer in Medicine, University of Dundee, was published by ARMS. In this study the 38 patients who underwent treatment were followed up for 22 days and were assessed by the same scale as that used by Fischer. Improvement in approximately one third of patients with bladder symptoms, sensory symptoms and ataxia was described but no benefit overall in other functions. In concluding his report Dr Davidson stated that there was a risk that numerous small units may be tempted to provide hyperbaric oxygen therapy while its benefits had not been established. He stressed that large double-blind controlled studies should be established in one or more centres using better assessment scales and examining treatment of both acute relapse as well as chronic multiple sclerosis.

Despite this warning form Dr Davidson, ARMS is proceeding with the establishment of 40 units to carry out treatment. The units are to be run by trained volunteers, no medical practitioner being in attendance during treatment . No controlled trials are being carried out by ARMS.

The Multiple Sclerosis Society in the UK has started four controlled trials. Results of these trials will be evaluated in 2 years.

The Medical Research Council (UK) has established a sub-committee on hyperbaric oxygen therapy. It is expected to report its findings to the Department of Health and Social Security next month.

In Australia hyperbaric oxygen therapy is being used in the treatment of spinal injuries but no recognised units in a medical setting in Australia are working in the area of multiple sclerosis.

Because of the nature of multiple sclerosis and in particular the great variety of symptomatology, and the variation in rate of progression of the disease in individual patients, large numbers of patients would need to be enrolled in a clinical trial in order to establish the effectiveness of the treatment. No one centre in Australia would be able to conduct such a trial; therefore it would be appropriate to await results of major trials being conducted overseas at present in order to assess this mode of treatment before establishing pilot treatment programs in Australia.